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BRER2017-014578-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: ROBERT CUNARD 52835 AVENIDA RAMIREZ LA QUINTA, CA 92253 Twit 4 4 QuiRrw DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT . RE -ROOF/ BRER2017-0145 52835 AVENIDA RAMIREZ 773322024 CUNARD RESIDENCE/ TILE $200.00 DEC 11 2011 L CITr CIF(A �OINTA "DEVELOP EPAATPENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: _ license No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of roperty who builds or improves thereon, and who contracts for the projects wit . a contractor(s) licensed pursuant to the Contractors' State License Law.).. (_) 14m a*mpt u4er Sec. . B.&P.C. ,brhhisyegson rr-i Owner: CONSTRUCTION LENDING AGENCY ' I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's N Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/11/2017 Owner: ROBERT CUNARD 52835 AVENIDA RAMIREZ LA QUINTA, CA 92253 Contractor: OWNER / BUILDER Llc. No.: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance . of the work for which this permit is Issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My workers' compensation insurance carrier and policy number are: Carrier: _. Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and ag5ee that, if I should become subject to the workers' co ens tion provisions of Se ion 3700 of the r Code, I shall forthwith complywit hos provisions Date Y'� rT SApplica WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER GE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOP. IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and stat that the above information is correct. I agree to comply with all city and county ordin ces and state laws relating to building construction, and her y authorize representa a of this to enter upon the above-mentioped pr perty for inspection pur Daie 1 ( Signature-(.Ap0ji a oo�ent.. '* Date: 12/11/2017 Application Number: BRER2017-0145 Owner: Property Address: 52835 AVENIDA RAMIREZ ROBERT CUNARC- APN: 773322024 52835 AVENIDA 2AMIREZ Application Description: CUNARD RESIDENCE/ TILE RESET LA QUINTA, CA 92253 Property Zoning: Application Valuation: $200.00 Applicant: Contractor: ROBERT CUNARD OWNER / BUILDER 52835 AVENIDA RAMIREZ LA QUINTA, CA 92253 Llc. No.: Detail: TILE RESET ONLY. PER 2016 CALIFORNIA.BUILDING CODE DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT BSAS SB1473 FEE j 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATIO V BSA: $1.00 DESCRIPTION . ACCOUNT QTY AMOUNT RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $53.05 DESCRIPTION ACCOUNT QTY AMOUNT RE -ROOF - FIRST 2,000 SF PC 101-0000-42600 0 $106.11 1 Total Paid for RE -ROOF: $159.16 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE:. TDTALS: $5.00 $165.16 t j s a - 1 S . t .......... PERMIT # D/ "/J PLAN LOCATION: Project Address: J;�'Z 47 3 o Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: Telephone: Patio/Por SF Email: Applicant Name: Sv State Lic: City,Bus Lic: Address: Z City, ST, Zip: Telephone: - _ ' T �e v - J lP �� S32�,3 Email: Valuation of Project $ ✓gym .� Contractor Name: New SFD Construction: Address: Conditioned Space SF City, St, Zip Garage SF. Telephone: Patio/Por SF Email: Fire Sprinklers SF State Lic: City,Bus Lic: J r Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Constru ion Type: Occupancy: Telephone: Bedrooms: Stories: # Units: Email State Lic: City Bus Lic: z Property Owner's Name: S�,yU,A� New Commercial/ enant Improvements: Address: Total Build' g SF City, ST, Zip Constru ion Type: Occupancy: Telephone: Email: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Req'd •Rec'd . � Y Plan Sets Structural Calcs ^f , Truss Calcs ' Title 24 Calcs Soils Report e P � Grading Plan (PM 10) Landscape Plan Subcontractor List 1 Grant Deed HOA Approval School Fees a Burrtec Debris Plan t Planning approval 3 Public.Works approval Fire approval ' City Business License . � Y ^f e P � 1 t 3 e P � 1 Ta�l _41_4- _a - "__ P.D. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 PROPERTY OWNER'S PACKAGE Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as &2e builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will "not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. . OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement. below to signify you understand or verify this information. 1. derstand a.frequent practice of unlicensed persons is to have the property owner o�tain an "Owner -Builder" bui ' g permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for. injuries to workers Gy property, 2__�Iunderstand . building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. I erstand as an "Owner -Builder" I am the responsible party of record on the permit. I une-erstand that I may protect rftyfrom potential financial risk by hiring a licensed Contractor and having the permit filed in his :)r her name instead of my own. @-4,-funderstand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. derstand if I employ or otherwise engage any persons, other than California licensed Contiactors, and the total value o y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" ,under state and federal law. understand if'I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. I understand under California Contractors' State License Law, an Owner -Builder who builds: single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work iE performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. . Y � A. I derstand as -an Owner -Builder if I sell the property for which this permit is issued, _- may be held liable for an financial -or -personal injuries ' sustained by any subsequent owner(s) that -result from ariy"lateht 60HSrucriori defed ' n the ' workmanship or materials. derstand I may obtain more information regarding my obligations as an "employer' from the Internal Revenue S ice, the U nitedited States Small.Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 8800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. qi Ail -em w�f and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally: and �finan a y 4esp ible fo roposed onstruction activity at the ' following address: v 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all a a le laws and requirements that govern Owner -Builders as.well as employers. notify the issuer of this form immediately of any additions, deletions, or change 3 to any of the information I 17e_pp=ovidFede,nnt0this form Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court, It is also important for you to understand that if an unlicensed Contractor or employee of that individual or fr_zrr is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issui the permit. Note. A copy of the property owner's driver's licanse, form notarization, or other verification acceptable to a agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of property owner Date: Note: The following Authorization Form is required to be completed by the property owe y nwhen designating an agent of the property owner to apply for a construction permit for the Owner -B ' r. AUTHORIZATION OF AGENT TO ACTON PRO TY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I under d is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign; and the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury th6 I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property'cwner s signature. Property Owner's Signature: Date: